REMEMBER SARS?

Daniel Kalla is an emergency room physician in Vancouver who confronted a case of SARS in 2003 and sat on the regional SARS Response Taskforce. The experience with SARS prompted him to write the best-selling novel Pandemic, which fictionalized a real scenario.

Photograph by: Gerry Kahrmann
, Vancouver Province

In my capacity as an ER physician, I recently came face-to-face, or more accurately mask-to-mask, with my first case of swine flu. My patient was admirably calm, but I still saw a glint of something in her eyes — fear of the unknown. The whole scenario was painfully reminiscent of our last big infectious threat.

Remember SARS?

In spring 2003, I attended the first city-wide SARS task force meeting. The virus had been named only days before and we knew very little about it, except that it was breaking all the usual rules and killing health-care workers in Asia. My gut reaction at the time could be summarized as: "We are all going to die!"

I remember when Dr. Patty Daly, Vancouver's chief medical health officer, calmly reassured everyone at the meeting that we were not facing Armageddon.

She explained that SARS did not possess the contagiousness or natural reservoirs (i.e. host animals aside from humans) to sustain itself. She preached a measured response.

I left the meeting still convinced we were all doomed, but time proved her right. Aside from the tragic situation in Toronto and a few other limited clusters, on a worldwide scale SARS turned out to be a tempest in a teapot. But it served a critically important purpose as a global dress rehearsal to help prepare us for the next pandemic influenza.

Now we are facing the swine flu, or H1N1 influenza, and the World Health Organization has raised its level of alarm to five out of six in terms of the threat of the virus evolving into the next pandemic.

In my novel, Pandemic, I envisioned how the world would react to a new threat. I imagined and characterized a worst-case scenario with rampant deaths, widespread panic and governmental collapse.

But the reality is that pandemics come and pandemics go, and no two are the same. History has taught us that we can expect a new strain of influenza to evolve every 30 or 40 years so different from previous viruses that it causes "antigenic shift" — in other words, the virus looks so unfamiliar to our immune systems that we have no natural immunity.

The reason we do not all get sick every flu season is that, to our immune systems, this year's flu virus looks enough like previous ones to give us partial immunity. Only a small percentage of people exposed to the annual flu virus, roughly 10 to 15 per cent, develop symptoms. This is not true of a pandemic, where the virus's infectivity is much higher.

The great pandemic of 1918-19, a.k.a. the Spanish flu, was the worst medical calamity in recorded time and among the most devastating natural disasters ever. A billion people became infected. Fifty to 100 million died. Most of those victims were young and previously healthy. We have not seen anything even close to it since, though the world has faced two more pandemics since the Spanish flu disappeared.

In the Asian flu of 1956, an estimated one to four million people died; a global death toll not much higher than that of the average flu season. The last pandemic, the Hong Kong flu of 1968, was even milder.

The burning question is not whether the swine flu will become a pandemic, but rather how many will develop severe illness or die. That is how pandemics leave their mark.

So far, in Canada no one has become critically ill from swine flu. The deaths have been primarily limited to Mexico, where most of the victims, disturbingly, have been young and healthy, but the overall fatality rate appears to have plateaued. While it is true that influenza viruses behave unpredictably, there is no evidence yet that the swine flu is going to be anywhere near as devastating as the Spanish flu was.

As a physician, I like to think I am measured in my response to the swine flu, but as a parent, I do feel a tad antsy.

The good news is there are steps we can take to minimize the risks of catching or (just as importantly) spreading the swine flu. Avoiding travel to any places known to have outbreaks of swine flu would be a good start.

But by far the best protective measure is to perform frequent and thorough hand-washing with soap and water or alcohol-based cleansers. Statistically, you are far more likely to catch the flu through hand contact than by being coughed or sneezed upon.

Staying away from hospitals, if possible, is always a good idea, but there are not enough cases to warrant keeping kids home from school or avoiding public places. Nor do you need to go outside gowned up like a cast member of CSI in mask and biohazard gear. If you choose to wear a mask on a flight or in a hospital, it will lower, but not eliminate, the risk of contracting swine flu.

If you have recently visited Mexico and you develop flu-like symptoms — fevers, fatigue, muscle aches, headache and cough — you should not go to the ER unless you feel very unwell. Otherwise, phone your family doctor or local clinic before visiting unannounced. If you have mild flu-like illness (as has been the case for every infected person in Canada so far), you only require the usual supportive treatment such as fluids, acetaminophen or ibuprofen.

The B.C. Centre for Disease Control has stockpiled thousands of doses of the antiviral agent Tamiflu — which has proven effective in treating severe cases of the swine flu — but people with mild illness or even typical flu symptoms do not require antiviral medication.

If you are unlucky enough to be infected with the swine flu, you do not need to be isolated 60 feet underground in a kryptonite-encased bunker. You simply have to stay home from work or school for one week following the onset of symptoms and wear a mask to protect those who live with you.

In a nutshell, use your common sense and you should be fine. Be responsible.

Cough into your sleeve, not your hand. Do not sneeze on people. And above all, wash your hands.

We do not know whether the swine flu will or will not reach pandemic proportion. But even if it does, the world will not end.

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Daniel Kalla is an emergency room physician in Vancouver who confronted a case of SARS in 2003 and sat on the regional SARS Response Taskforce. The experience with SARS prompted him to write the best-selling novel Pandemic, which fictionalized a real scenario.

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